Birth weight in pre-eclamptic and normotensive twin pregnancies: an analysis of discordance and growth restriction. (17/812)

The aim of this study was to verify whether twin pregnancies complicated by pre-eclampsia were associated with a higher rate of inter-twin weight discordance or an increased prevalence of small for gestational age (SGA) neonates than in normotensive twin pregnancies. A 17 year retrospective study was undertaken by examining 76 twin pregnancies complicated by pre-eclampsia and comparing them with 400 normotensive twin pregnancies. The case notes were reviewed in reference to birth weight differences, birth order, pregnancy outcome and inter-twin birth weight discordance. Statistical analyses were performed with t-test, contingency tables, regression curves, rank sum test and non-parametric survival plots. Power analysis was also carried out. Pre-eclamptic twin pregnancies were delivered at similar weeks of gestation to normotensive. They resulted in a smaller size for the second twin the earlier the delivery week, while in normotensive twin pregnancies no significant difference occurred at any week. Twin pregnancies complicated by pre-eclampsia showed higher rates of SGA neonates among second twins than those with normal pressure. The >25% discordance was associated with lower gestational age at delivery in each group [mean (range) 33 weeks (27-38) versus 37 (29-41), P < 0.005 pre-eclampsia and 35 weeks (25-41) versus 38 (25-42), P < 0.001 normotensive]. In pre-eclampsia the concomitant occurrence of SGA second twin and the discordance >25% was associated with shorter gestation while the presence of SGA second twin alone was not.  (+info)

Socioeconomic and work related determinants of pregnancy outcome in southern Thailand. (18/812)

STUDY OBJECTIVE: To examine the effect of socioeconomic status on pregnancy outcome in an urbanised area in a rapidly developing country. METHODS: A cohort of 1797 pregnant women who attended antenatal care clinics at the two 700 bed hospitals in Hatyai city was recruited from September 1994 to November 1995. The pregnant women were followed up from the 17th week of gestation until delivery. The socioeconomic indicators selected were family socioeconomic status, maternal education, maternal occupation, family income and work exposure characteristics based upon Karasek's job content questionnaires. Pregnancy outcomes were birth weight, low birth weight, small for gestational age and preterm delivery. MAIN RESULTS: Mean birth weight correlated with socioeconomic status and income but after adjustment for parity, maternal age and height, weight at delivery day, baby sex, obstetrical complications and antenatal care utilisation, only family income remained correlated with birth weight. No association with any socioeconomic status indicators was found when using dichotomous outcome (low birth weight, small for gestational age or preterm delivery). Only high psychological job demand was associated with small for gestational age. Confounder adjustment indicated that the observed social status differences in pregnancy outcomes were mainly attributable to mother's characteristics and antenatal service use. CONCLUSIONS: Socioeconomic indicators alone were not associated with reduced fetal growth or preterm delivery in this study, which recruited mainly lower or middle class women. Karasek's psychological job demand was only weakly correlated with small for gestational age infant.  (+info)

A randomized, placebo-controlled trial of the effect of zinc supplementation during pregnancy on pregnancy outcome in Bangladeshi urban poor. (19/812)

BACKGROUND: Maternal zinc supplementation has been suggested as a potential intervention to reduce the incidence of low birth weight in developing countries. To date, placebo-controlled trials have all been performed in industrialized countries and the results are inconsistent. OBJECTIVE: The objective of this study was to evaluate whether zinc supplementation in Bangladeshi urban poor during the last 2 trimesters of pregnancy was associated with pregnancy outcome. DESIGN: We conducted a double-blind, placebo-controlled trial in which 559 women from Dhaka slums, stratified by parity between 12 and 16 wk of gestation, were randomly assigned to receive 30 mg elemental Zn/d (n = 269) or placebo (n = 290). Supplementation continued until delivery. Serum zinc was estimated at baseline and at 7 mo of gestation. Dietary intake was assessed at baseline and anthropometric measurements were made monthly. Weight, length, and gestational ages of 410 singleton newborns were measured within 72 h of birth. RESULTS: At 7 mo of gestation, serum zinc concentrations tended to be higher in the zinc-supplemented group than in the placebo group (15.9 +/- 4.4 compared with 15.2 +/- 4.3 micromol/L). No significant effect of treatment was observed on infant birth weight (2513 +/- 390 compared with 2554 +/- 393 g; NS) or on gestational age, infant length, or head, chest, or midupper arm circumference. The incidence and distribution of low birth weight, prematurity, and smallness for gestational age also did not differ significantly after zinc supplementation. CONCLUSIONS: Supplementation with 30 mg elemental Zn during the last 2 trimesters of pregnancy did not improve birth outcome in Bangladeshi urban poor. These results indicate that interventions with zinc supplementation alone are unlikely to reduce the incidence of low birth weight in Bangladesh.  (+info)

Pregnancy outcome in women with insulin-dependent diabetes mellitus complicated by nephropathy. (20/812)

We retrospectively analysed pregnancy complicated by diabetic nephropathy in patients attending a University teaching hospital (1990-97), to examine fetal/maternal outcomes. Fetal outcomes included early intrauterine deaths, stillbirths, neonatal/perinatal mortality, size for gestational age, malformations, and need for neonatal unit care. Maternal outcomes included change in frequency of hypertension or severe proteinuria, serum creatinine data, and caesarean section rate. There were 21 pregnancies in 18 women, resulting in 21 live infants. Neonatal mortality (RR 10, 95% CI 0-3.9), perinatal mortality (RR 5, 95% CI 0-3.3) and congenital malformations (RR 5.0, 95% CI 0.3-26.3) were greater than in the background population. At delivery, 76% of babies were appropriate in size for gestational age; 57% were preterm, all of whom required neonatal unit care. The caesarean section rate was 90.5% vs. 20% in the background population (RR 4.5, 95% CI 3.4-5.0) (p < 0.05). Hypertension frequency (p < 0.001) and high-grade proteinuria (p < 0.05) increased from booking to delivery. Although the take-home baby rate was 90%, perinatal/neonatal mortality, congenital malformations and caesarean sections, in addition to maternal morbidity, were significantly higher in women with diabetic nephropathy than in the background population.  (+info)

Neonatal hypoglycaemia in Nepal 2. Availability of alternative fuels. (21/812)

AIMS: To study early neonatal metabolic adaptation in a hospital population of neonates in Nepal. METHODS: A cross sectional study was made of 578 neonates, 0 to 48 hours after birth, in the main maternity hospital in Kathmandu. The following clinical and nutritional variables were assessed: concentrations and age profiles of blood glucose, hydroxybutyrate, lactate, pyruvate, free fatty acids (FFA) and glycerol; associations between alternative fuel levels and hypoglycaemia; and regression of possible risk factors for ketone availability. RESULTS: Risk factors for impaired metabolic adaptation were common, especially low birthweight (32%), feeding delays, and cold stress. Blood glucose and ketones rose with age, but important age effects were also found for risk factors like hypothermia, thyroid hormone activities, and feeding practices. Alternative fuel concentrations, except FFA, were significantly reduced in infants with moderate hypoglycaemia during the first 48 hours after birth. Unlike earlier studies, small for gestational age (SGA) infants had significantly higher hydroxybutyrate:glucose ratios which suggested counter regulatory ketogenesis. Hypoglycaemic infants were not hyperinsulinaemic. Regression analysis showed risk factors for impaired counter regulation which included male and large infants, hypothermia, and poorer infant thyroid function. SGA infants and those whose mothers had received no antenatal care had increased counter regulation. CONCLUSIONS: Alternative fuels are important in the metabolic assessment of neonates, and they might provide effective cerebral metabolism even during moderate hypoglycaemia. Hypoglycaemic infants generally had lower concentrations of alternative fuels through either reduced availability or increased consumption. SGA and post term infants increased counter regulatory ketogenesis with early neonatal hypoglycaemia, but hypothermia, male gender, and low infant T4 were associated with impaired counter regulation after birth.  (+info)

Foot length in fetuses with abnormal growth. (22/812)

Sonographic fetal foot length is highly predictive of gestational age. In order to assess the reliability of this parameter in predicting gestational age in cases of abnormal fetal growth, we examined fetal foot length in small- and large-for-gestational-age fetuses. A nomogram of foot length versus gestational age between 15 and 37 weeks was constructed using cross-sectional data obtained from 5372 singleton fetuses. Fetal foot lengths for small-for-gestational-age fetuses (estimated fetal weight below the 10th percentile) and large-for-gestational-age fetuses (above the >90th percentile) fetuses were plotted against the foot length nomogram in order to determine the number of small-for-gestational-age fetuses and large-for-gestational-age fetuses with foot lengths below the 10th and above the 90th percentiles, respectively. Of the 586 small-for-gestational-age fetuses, 355 (60.6%) had foot lengths below the 10th percentile on the nomogram. When foot lengths from large-for-gestational-age fetuses were plotted on the foot length nomogram, 29.4% (219 of 744) had measurements above the 90th percentile. Fetal foot length can be influenced by growth restriction as well as states of accelerated fetal growth. Our findings imply that there are limitations to the use of fetal foot length for gestational age assessment, particularly in fetuses with growth abnormalities.  (+info)

Concordance among measures of pregnancy outcome based on fetal size and duration of gestation. (23/812)

Epidemiologic and clinical studies of pregnancy outcome often consider a variety of related, overlapping outcome measures. The overlap among these measures was analyzed using data from the Mount Sinai Hospital Perinatal Data Base, New York City, New York. A total of 52,621 births from 1986 through 1996 were included, with information on gender, ethnicity, birth weight, and gestational age assigned based on last menstrual period or early ultrasound. The authors considered very low birth weight (VLBW) (<1,500 g), low birth weight (LBW) (<2,500 g), degrees of preterm delivery (less than 32, 34, and 37 weeks' gestation), and small for gestational age (less than the 10th percentile of weight for gestational age) births. Infants at the extremes of gestational age (<32 or 34 weeks' gestation) were almost always LBW (97.6 and 91.7%, respectively), and those who were VLBW were almost always preterm (99.2%). However, only 69.2% of LBW infants were preterm, and 50.2% of preterm infants were LBW (kappa = 0.54). Only for VLBW and less than 32 weeks' gestation were both measures of overlap at least 70% (kappa = 0.98). The lack of concordance among measures suggests that multiple outcome measures be considered and that results from analyses using disparate measures not be compared directly.  (+info)

Effects of gestation and birth weight on the growth and development of very low birthweight small for gestational age infants: a matched group comparison. (24/812)

AIMS: To investigate the effects of small for gestational age (SGA) in very low birthweight (VLBW) infants on growth and development until the fifth year of life. METHODS: VLBW (< 1500 g) infants, selected from a prospective study, were classified as SGA (n = 115) on the basis of birth weight below the 10th percentile for gestational age and were compared with two groups of appropriate for gestational age (AGA) infants matched according to birth weight (AGA-BW; n = 115) or gestation at birth (AGA-GA; n = 115). Prenatal, perinatal, and postnatal risk factors were recorded, and duration and intensity of treatment were computed from daily assessments. Body weight, length, and head circumference were measured at birth, five and 20 months (corrected for prematurity), and at 56 months. General development was assessed at five and 20 months with the Griffiths scale of babies abilities, and cognitive development at 56 months with the Columbia mental maturity scales, a vocabulary (AWST) and language comprehension test (LSVTA). RESULTS: Significant group differences were found in complications (pregnancy, birth, and neonatal), parity, and multiple birth rate. The AGA-GA group showed most satisfactory growth up to 56 months, with both the AGA-BW and SGA groups lagging behind. The AGA-GA group also scored significantly more highly on all developmental and cognitive tests than the other groups. Developmental test results were similar for the SGA and AGA-BW groups at five and 20 months, but AGA-BW infants (lowest gestation) had lower scores on performance intelligence quotient and language comprehension at 56 months than the SGA group. When prenatal and neonatal complications, parity, and multiple birth were accounted for, group differences in growth remained, but differences in cognitive outcome disappeared after five months. CONCLUSIONS: Being underweight and with a short gestation (SGA and VLBW) leads to poor weight gain and head growth in infancy but does not result in poorer growth than in infants of the same birth weight but shorter gestation (AGA-BW) in the long term. SGA is related to early developmental delay and later language problems; however, neonatal complications may have a larger detrimental effect on long term cognitive development of VLBW infants than whether they are born SGA or AGA.  (+info)